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PubMed1993

Profile of depressive symptoms in younger and older medical inpatients with major depression.

OBJECTIVE: To examine and compare the profile of cognitive symptoms, somatic symptoms, and somatic complaints in younger and older medical inpatients diagnosed with major depressive disorder (MDD). DESIGN: Cross-sectional cohort. PATIENTS AND SETTING: Male patients aged 20-39 years (n = 116) and aged 70-102 years (n = 332), consecutively admitted to the medical and neurological services of a VA medical center, underwent psychiatric evaluations for depression. MEASUREMENTS: Depressive symptoms were measured using the observer-rated Hamilton Depression Scale and the self-rated Geriatric Depression Scale using an "inclusive" approach (symptoms rated regardless of etiology). Data on 12 common somatic complaints were also collected. Clinical diagnoses of MDD were made by a psychiatrist based on the Diagnostic Interview Schedule and other psychiatric and physical health data. RESULTS: After controlling for severity of medical illness, functional status, and alcohol use, symptoms that discriminated MDD best among younger men were loss of interest, feelings of guilt or of being a burden, suicidal thoughts, and depressed mood (primarily cognitive and affective symptoms). Among older men, loss of interest, insomnia, suicidal thoughts, and hypochondriasis most strongly differentiated depressed from non-depressed patients (mixture of cognitive and somatic symptoms); fatigue, weight loss, genital symptoms, and somatic anxiety were weakly related or unrelated to MDD. Number of somatic complaints (headache, dizziness, palpitations, etc.) helped differentiate patients with MDD; although equally common among depressed young and older patients, a distinct pattern of complaints emerged in each age group. CONCLUSIONS: Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non-depressed patients with medical illness.

Activities of Daily Living↗
PubMed1981

Cognitive style in depressed and recovered depressed patients.

Depressed and recovered depressed patients were compared with a recovered mixed psychiatric group and normal controls on three cognitive measures relating to Beck's theory of depression. Levels of depression and neuroticism were also assessed. Cognitive response was not found to differentiate the recovered depressed patients from the two control groups, though depressed patients were consistently differentiated. The three cognitive measures, of which one was devised by the authors, intercorrelated highly among themselves and with levels of depression and neuroticism. When levels of depression and neuroticism were controlled for, the differences between the depressed group, recovered depressed and control groups, disappeared, except on one of the measures. The implications of the findings for the cognitive theory of depression are discussed.

Cognition↗
PubMed1992

Causal beliefs about depression in depressed patients, clinical psychologists and lay persons.

Non-depressed lay persons have been shown to have extensive and accurate knowledge about depression (Rippere, 1977, 1980 a, b, 1981 a) that is underpinned by a structure that resembles current academic theories of the disorder (Furnham & Kuyken, 1991). In this study a semi-structured interview schedule and a number of rating scales were used to determine and compare the nature and extent of depressed patients', clinical psychologists', and lay persons' beliefs about the causes of depression. We confirmed that depressed patients and non-depressed lay persons alike have relatively extensive beliefs about the causes of depression which are comparable to those held by clinical psychologists. However, depressed patients tend to endorse biological explanations of the causes of depression to a greater extent than clinical psychologists. In contrast, clinical psychologists assign a more important causal role to unconscious processes and childhood vulnerability factors than do either depressed patients or non-depressed lay controls.

Adjustment Disorders↗
PubMedDate not supplied

Psychopathological symptoms of depression in Parkinson's disease compared to major depression.

Parkinson's disease is frequently associated with depressive symptoms. When depression occurs at early stages and before the onset of characteristic motor symptoms of the disease, differential diagnosis of major depression may be difficult. Differences in psychopathological features of depression in Parkinson's disease and major depression have been reported by some authors. This study presents data of 49 patients with depression in Parkinson's disease and 38 patients with major depression. The severity of depressive symptoms was equivalent in both groups. Depressive features did not differ between the two groups with exception of affective flattening, delusional ideas and suicide attempts. In conclusion, this investigation gives support to the assumption of a common neurobiological origin of depression in Parkinson's disease and major depression.

Affect↗
PubMed2000

Three-year follow-up of women with the sole diagnosis of depressive personality disorder: subsequent development of dysthymia and major depression.

OBJECTIVE: The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects. METHOD: Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression. RESULTS: At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance. CONCLUSIONS: The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.

Adult↗
PubMed2003

Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up.

OBJECTIVE: While guidelines for treating patients with bipolar depression recommend discontinuing antidepressants within 6 months after remission, few studies have assessed the implications of this strategy on the risk for depressive relapse. This study examined the effect of antidepressant discontinuation or continuation on depressive relapse risk among bipolar subjects successfully treated for an acute depressive episode. METHOD: Eighty-four subjects with bipolar disorder who achieved remission from a depressive episode with the addition of an antidepressant to an ongoing mood stabilizer regimen were followed prospectively for 1 year. The risk of depressive relapse among 43 subjects who stopped antidepressant treatment within 6 months after remission ("discontinuation group") was compared with the risk among 41 subjects who continued taking antidepressants beyond 6 months ("continuation group"). RESULTS: A Cox proportional hazards regression analysis indicated that shorter antidepressant exposure time following successful treatment was associated with a significantly shorter time to depressive relapse. Furthermore, patients who discontinued antidepressant treatment within the first 6 months after remission experienced a significantly shorter period of euthymia before depressive relapse over the length of 1-year follow-up. One year after successful antidepressant response, 70% of the antidepressant discontinuation group experienced a depressive relapse compared with 36% of the continuation group. By the 1-year follow-up evaluation, 15 (18%) of the 84 subjects had experienced a manic relapse; only six of these subjects were taking an antidepressant at the time of manic relapse. CONCLUSIONS: The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission. The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and, overall, was substantially less than the risk of depressive relapse. Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patients with bipolar disorder.

Acute Disease↗
PubMed2006

Clinical features of bipolar depression versus major depressive disorder in large multicenter trials.

OBJECTIVE: Failure to recognize bipolar disorder in patients who experience a major depressive episode may lead to inappropriate treatment and poorer outcomes. Clinical features that could distinguish bipolar from unipolar depression would facilitate more appropriate treatment selection. METHOD: The authors used data from nonpsychotic outpatients participating in three large multicenter clinical trials conducted in the United States for the treatment of major depressive episodes to compare 477 subjects with a diagnosis of bipolar disorder and 1,074 with major depressive disorder. RESULTS: Bipolar depression was associated with family history of bipolar disorder, an earlier age at onset, a greater previous number of depressive episodes, and eight individual symptom items on the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale. Fears were more common in patients with bipolar disorder, whereas sadness; insomnia; intellectual (cognitive), somatic (muscular), respiratory, genitourinary complaints; and depressed behavior were more common in patients with unipolar depression. A logistic regression model correctly classified 86.9% of the subjects. CONCLUSIONS: Bipolar depression and major depressive disorder exhibit subtle differences in presentation, which may help guide the initial diagnosis.

Adult↗
PubMed2006

Depression outcomes and quality of postdischarge care of elders hospitalized for major depression.

OBJECTIVES: Elders with depression are disproportionately hospitalized, and they depend on postacute care for recovery. The authors hypothesized that higher quality of postacute care would be associated with better depression outcomes for older adults six months after discharge for inpatient psychiatric care. The study also explored the time frame in which effects of quality of care on depression outcomes were manifested. METHODS: The sample consisted of 148 elders (ages 60-95 years) who were hospitalized for major depression and discharged to their homes. Quality of care was measured by the extent to which services met patients' needs. Specifically, quality of care was assessed by whether four domains of needs (psychiatric, medical, functional, and psychosocial) were met six weeks and six months postdischarge. Depression outcomes at six months were measured by the Geriatric Depression Scale. RESULTS: In bivariate analyses at six weeks, no quality-of-care variables were associated with depression outcomes, but in bivariate analyses at six months, quality of functional and psychosocial care was related to depression outcomes. Multivariate analyses revealed that those whose psychosocial needs were unmet at six months showed worse depression outcomes. CONCLUSIONS: Findings provided partial support for the association between quality of care and depression outcomes, in that quality of psychosocial care was associated with better outcomes. Also, the findings suggest that the relationship between quality of psychosocial care and depression outcomes may be evident after six months of postacute care.

Aged↗
PubMed2006

Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression.

BACKGROUND: Little is known about longitudinal associations among measures of depression, mental and physical health, and quality of life (QOL). We followed 982 clinically depressed persons to determine which measures changed and whether the change was synchronous with change in depressive symptoms. METHODS: Data were from the Longitudinal Investigation of Depression Outcomes (LIDO). Depressive symptoms, physical and mental health, and quality of life were measured at baseline, 6 weeks, 3 months, and 9 months. Change in the measures was examined over time and for persons with different levels of change in depressive symptoms. RESULTS: On average, all of the measures improved significantly over time, and most were synchronous with change in depressive symptoms. Measures of mental health changed the most, and physical health the least. The measures of change in QOL were intermediate. The 6-week change in QOL could be explained completely by change in depressive symptoms. The instruments varied in sensitivity to changes in depressive symptoms. CONCLUSION: In clinically depressed persons, measures of physical health, mental health, and quality of life showed consistent longitudinal associations with measures of depressive symptoms.

Adolescent↗
PubMed1994

Heterogeneity of depression. Classification of depressive subtypes by longitudinal course.

This paper describes the application of prospective longitudinal data from an epidemiological sample of young adults to define subtypes of major depression. Depression was classified on a spectrum from subthreshold manifestation of symptoms and duration at one end, to cases with recurrent episodes of depression meeting duration criteria for major depressive episodes at the other. There was a direct relationship between the severity of depression over the longitudinal course and both duration and recurrence of depressive episodes. The subgroup of depression with recurrence of both brief and longer duration episodes could be discriminated on most of the indicators of validity including symptoms, impairment, family history, and suicide attempts. In light of the young age of this cohort, the strong history of suicide attempts and other complications of depression among the subjects with recurrent depression was striking. These findings underscore the importance of employing course as a classification criterion of depression, and the inclusion of subthreshold episodes of depression in the characterization of course.

Adult↗
PubMed2002

Overcoming depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program.

BACKGROUND: Psychoeducational programs are increasingly being delivered over the Internet. We created an Internet-based, cognitive therapy, self-help program to be used as a stand-alone intervention for mild-to-moderate depression, or as an adjunct to traditional services for more severe depression. OBJECTIVE: To evaluate the effectiveness of a web-based intervention program to reduce depression in a randomized, controlled trial. METHODS: In a private, nonprofit health maintenance organization, we mailed recruitment brochures to two populations: depressed adults (n = 6994) who received traditional medical services for depression, and an age/gender matched sample of nondepressed adults (n = 6996). Participants consenting to the study were randomized to either the experimental Web site (n = 144), or a no-access control group (n = 155). Participants in both groups were free to obtain nonexperimental, usual care services for their depression. All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale (CES-D) at enrollment and at 4-, 8-, 16- and 32-weeks after enrollment. Mean intake scores were in the severely depressed range. 74% of participants completed at least one follow-up assessment. Unfortunately, most intervention participants accessed the Internet site infrequently. RESULTS: We failed to find an effect for the Internet program across the entire sample. However, post-hoc, exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake. CONCLUSIONS: The negative results might have resulted from infrequent patient use of the Internet site, or a more seriously depressed sample than the intervention was intended to help. Future studies should focus on recruiting persons with mild to moderate levels of depression, and on increasing participant use of the Internet site.

Adult↗
PubMed2005

Depression and diabetes: a large population-based study of sociodemographic, lifestyle, and clinical factors associated with depression in type 1 and type 2 diabetes.

OBJECTIVE: The purpose of this study was to investigate factors associated with depression in type 1 and type 2 diabetes and test whether these differ from factors associated with depression in the nondiabetic population. RESEARCH DESIGN AND METHODS: In an unselected population study comprising 60,869 individuals, potential sociodemographic, lifestyle, and clinical factors were investigated in participants with and without diabetes. The associations between hyperglycemia and depression in types 1 and 2 diabetes were also studied. The levels of depression were self-rated by using the Hospital Anxiety and Depression Scale. RESULTS: Several factors were correlated with depression in types 1 and 2 diabetes. However, these factors were not different from those of the nondiabetic population. Comorbid chronic somatic diseases were associated with depression in type 2 but not type 1 diabetes. In type 2 diabetes, those without comorbidity had the same odds of depression as the nondiabetic population with no chronic somatic diseases. No significant associations were found for hyperglycemia in relation to depression in type 1 and type 2 diabetes. CONCLUSIONS: Type 2 diabetes without other chronic somatic diseases did not increase the risk of depression. Factors associated with depression in type 1 and type 2 diabetes were shared with the nondiabetic population.

Adult↗
PubMedDate not supplied

Are you often sad and depressed? Brief measures to identify women at risk for depression in pregnancy.

PURPOSE: The purpose of this study was to test brief depression screening measures as an initial step to identify women at risk for depression in pregnancy. STUDY DESIGN AND METHODS: Psychometric theory and a prospective correlational research design with a convenience sample of 130 low-income women guided this study. Measurements included (a) single-item depression-screening measures, (b) a two-item depression screening measure, (c) the Brief Depression Screen (BDS), and (d) the Beck Depression Inventory-II (BDI-II), a standardized measure of self-reported depression that has been used widely in pregnancy. RESULTS: Depressive symptoms in pregnancy among these low-income women were 27% (35/128) as determined by a score of 16 or greater on the BDI-II. The two-item depression screening measure, "Are you often sad and depressed?" and "Have you had a loss of pleasurable activities?" had a sensitivity of 91% and a specificity of 52%, whereas the BDS measure had sensitivity of 53% and specificity of 80%. CLINICAL IMPLICATIONS: Asking the two-item screening questions could be an essential first step in determining which women should receive further evaluation and interventions aimed at treating depression during pregnancy.

Adult↗
PubMed1985

Developmental differences in depression: cognitive-perceptual distortion in adolescent versus adult female depressives.

This study was undertaken to determine differential cognitive-perceptual distortion in depression for adolescent versus adult females. Twenty-five female adolescent and twenty-five female adult psychiatric inpatients served as subjects. Each had received a primary diagnosis of neurotic or reactive depression and had completed the Beck Depression Inventory within five days of hospitalization. Results indicated significant similarities between the groups in anger at self and sense of failure. These may serve as unifying themes for adolescent and adult depressives. Results also indicated significant differences between the two groups. Adult female depressives demonstrated an internalized, ruminative focus to their depressive cognitions. Adolescent female depressives demonstrated an externalized focus to their depressive cognitions. Adults demonstrated a preoccupation with their own view of themselves and perceived themselves as a failure in their own eyes. Adolescents demonstrated a preoccupation with how others view them and perceived themselves as a failure in the eyes of others. These results are discussed in terms of developmental, theoretical, and treatment issues for adolescent versus adult depressives generally. Depression may exacerbate cognitive-perceptual distortions already existing within the adolescent population. In treatment, group psychotherapy may prove particularly efficacious for adolescent depressives.

Adjustment Disorders↗
PubMed1991

Contrasts between symptoms of summer depression and winter depression.

Epidemiological studies and studies of clinical populations suggest that there are primarily two opposite patterns of seasonally recurring depressions: summer depression and winter depression. In addition, there is preliminary evidence that the two seasonal types of depression may have opposite types of vegetative symptoms. In the present study, we prospectively monitored symptoms of depression in 30 patients with recurrent summer depression and 30 sex-matched patients with recurrent winter depression and compared the symptom profiles of the two groups. Consistent with predictions based on the earlier reports, we found that winter depressives were more likely to have atypical vegetative symptoms, with increased appetite, carbohydrate craving, weight gain and hypersomnia, and that summer depressives were more likely to have endogenous vegetative symptoms, with decreased appetite and insomnia. A cluster analysis performed on the patients' symptom profiles without reference to season of occurrence of their episodes separated 78% of the summer depressives and winter depressives from each other on the basis of their symptoms (chi 2 = 19.29, P less than 0.001).

Adult↗
PubMed2004

Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial.

CONTEXT: Suicide rates are highest in late life; the majority of older adults who die by suicide have seen a primary care physician in preceding months. Depression is the strongest risk factor for late-life suicide and for suicide's precursor, suicidal ideation. OBJECTIVE: To determine the effect of a primary care intervention on suicidal ideation and depression in older patients. DESIGN AND SETTING: Randomized controlled trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) with patient recruitment from 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions, May 1999 through August 2001. PARTICIPANTS: Two-stage, age-stratified (60-74, > or =75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of screened negative patients. This analysis included patients with a depression diagnosis (N = 598). INTERVENTION: Treatment guidelines tailored for the elderly with care management compared with usual care. MAIN OUTCOME MEASURES: Assessment of suicidal ideation and depression severity at baseline, 4 months, 8 months, and 12 months. RESULTS: Rates of suicidal ideation declined faster (P =.01) in intervention patients compared with usual care patients; at 4 months, in the intervention group, raw rates of suicidal ideation declined 12.9% points (29.4% to 16.5%) compared with 3.0% points (20.1% to 17.1% in usual care [P =.01]). Among patients reporting suicidal ideation, resolution of ideation was faster among intervention patients (P =.03); differences peaked at 8 months (70.7% vs 43.9% resolution; P =.005). Intervention patients had a more favorable course of depression in both degree and speed of symptom reduction; group difference peaked at 4 months. The effects on depression were not significant among patients with minor depression unless suicidal ideation was present. CONCLUSIONS: Evidence of the intervention's effectiveness in community-based primary care with a heterogeneous sample of depressed patients introduces new challenges related to its sustainability and dissemination. The intervention's effectiveness in reducing suicidal ideation, regardless of depression severity, reinforces its role as a prevention strategy to reduce risk factors for suicide in late life.

Aged↗
PubMed2003

Larger amygdala volumes in first depressive episode as compared to recurrent major depression and healthy control subjects.

BACKGROUND: The aim of our study was to test the hypothesis that amygdala volumes are reduced in patients with recurrent major depression compared with first episode patients. METHODS: Using structural magnetic resonance imaging, we compared 30 inpatients with first-episode depression and 27 inpatients with recurrent major depression (DSM-IV) with healthy volunteer subjects from the local community matched for age, gender, and handedness. RESULTS: Patients with first-episode depression showed enlarged amygdala volumes compared with patients with recurrent major depression and healthy control subjects. No significant differences were found between patients with recurrent depression and healthy control subjects. No significant correlations were found between amygdala volumes and age of onset, illness duration, or severity of depression. CONCLUSIONS: Larger amygdala volumes in patients with first-episode depression may result from higher amygdala metabolism and blood flow. Additionally, disease progression with stress-related excitotoxic processes during recurrent depressive episodes might result in decreased amygdala volumes. Prospective investigations to investigate amygdala changes during the course of depression are needed.

Adult↗
PubMed1999

Depressive personality in the relatives of outpatients with dysthymic disorder and episodic major depressive disorder and normal controls.

BACKGROUND: This study examined whether there is a familial relationship between depressive personality and the mood disorders. METHOD: Rates of depressive personality were compared in 161 relatives of outpatients with dysthymic disorder (DD), 75 relatives of outpatients with non-chronic major depressive disorder (MDD), and 90 relatives of normal controls. All probands and relatives were evaluated using structured diagnostic interviews for Axis I disorders and depressive personality traits. RESULTS: The relatives of patients with DD exhibited a significantly higher rate of depressive personality than the relatives of normal controls, while the relatives of patients with MDD fell in between, and did not differ from, the other two groups. These results held after controlling for a lifetime history of mood disorder in the relatives, and could not be explained by an increased rate of depressive personality in the DD probands. LIMITATIONS: The sample size was modest, comorbid non-mood Axis I and II disorders in the relatives were not controlled, and DSM-IV criteria for depressive personality disorder were not yet available at the time the study was undertaken. CONCLUSION: These findings are consistent with the view that depressive personality is part of a spectrum of mood disorders with a shared familial liability, but suggest that this link is strongest with chronic forms of depression such as DD and double depression.

Adult↗