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PubMed1986

Assessment of depression and diagnosis of depressive disorder among psychiatrically disturbed children.

This study examined the relations between performance on alternative measures of childhood depression and diagnosis of depressive disorder. Hospitalized inpatient children (N = 170, ages 7-13) with a diagnosis of depressive disorder (Research Diagnostic Criteria) were compared with a matched sample of patients whose diagnoses excluded depression. Children and parents completed four standardized depression scales plus measures designed to assess associated features including hopelessness, self-esteem, and internalizing symptoms. The results indicated that alternative depression measures, whether completed by children or parents, yielded scores that were significantly higher for children with a diagnosis of depression; parent ratings of severity of depression were consistently higher among the measures than the child ratings; optimal cutoff scores derived for each measure correctly classified approximately 60% of depressed and nondepressed cases; different cutoff scores were required for the same measure, depending on whether children or parents were the raters; and using a battery of measures and combining these in a stepwise discriminant function yielded over 80% classification accuracy. The implications of the results for selection of cases for clinical research are discussed.

Adolescent↗
PubMed2004

Assessing dimensional and categorical aspects of depression: validation of the AMDP Depression Scale.

BACKGROUND: A new observer depression scale which is based on the descriptive operationalized classification principles of ICD-10 is introduced. The AMDP Depression Scale (AMDP-DS), a 22-item clinician-rated inventory, provides the opportunity of dimensional as well as categorical depression severity assessment. METHODS: A sample of 50 patients with depressive symptoms were assessed with the AMDP-DS by two raters in a joint rater session. A number of widely used depression scales were applied separately by an independent rater. The ICD-10 symptom checklist was used for categorical assessment of depressive disorders. RESULTS: The inter-rater reliability for the total score of the AMDP-DS was excellent (Intraclass coefficient: 0.97). There were high correlations with the sum scores of the other scales under study. The correlations between the ICD-10 symptom-checklist and the AMDP-DS ranged from 0.75 to 0.89 for the total sample and 0.44 to 0.51 for patients with acute depressive episode. LIMITATIONS: The results are limited by the method of a joint rater setting and the relatively small subsample of patients with depressive episode. CONCLUSIONS: The AMDP-DS satisfies the requirements of psychometric criteria with a sufficient degree. A new depression scale designed to cover dimensional as well as categorical aspects has successfully been developed.

Adult↗
PubMed1994

Lower serum prolyl endopeptidase enzyme activity in major depression: further evidence that peptidases play a role in the pathophysiology of depression.

Prolyl endopeptidase (PEP) is a serine proteinase, which may cleave peptides that are involved in the pathophysiology of major depression, such as arginine vasopressin, beta-endorphin, luteinizing hormone-releasing hormone, thyrotropin-releasing hormone, and maybe corticotropin-releasing hormone. PEP may be involved in activation of cell-mediated immunity, autoimmune and inflammatory responses, which repeatedly occur in severe depression. The present study investigates serum PEP activity in 33 normal controls, 16 minor, 14 simple major, and 18 melancholic depressed subjects. Pre-dexamethasone and post-dexamethasone (DST) intact adrenocorticotropic hormone (ACTH) and cortisol values were determined in 33 depressed subjects. Serum PEP activity was significantly lower in depressed subjects compared to normal controls and in melancholic depressed subjects compared to minor and simple major depressed subjects. Up to 61.1% of the melancholic patients had serum PEP activities below the mean PEP values of normal controls minus two SDs. In the depressed study group, significant negative correlations between serum PEP activity and severity of illness, post-DST cortisol, and ACTH values were observed. There was a trend toward higher serum PEP activity with increasing age. It is hypothesized that lower serum PEP activity, and lower serum activity of other peptidases, may play a role in the neuroendocrine and immune pathophysiology of major depression.

Adrenocorticotropic Hormone↗
PubMed1993

Depressed patients' parental representations: stability across changes in depressed mood and specificity across diagnoses.

Parental representations of a Dutch sample of psychiatric patients with diagnoses of dysthymia and unipolar depression were compared with those of a matched sample of non-depressed patients and a matched sample of healthy controls. No differences in recalled parental rearing styles were found between depressives with a diagnosis of dysthymia and those with a diagnosis of unipolar depression. Depressive did not differ from the mixed (but non-depressed) sample of psychiatric patients, whereas both the depressed and the mixed group of patients reported more adverse parenting than the healthy controls. Analysis of repeated measurements of parental representations showed that memories of parental behavior were highly stable across clinically significant changes in depressed mood, so that it seems unlikely that patients' relatively negative recollections of their parents' behavior were due to mood state dependent recall. Results are discussed within the framework of depression theories and with regard to the validity and utility of self-report instruments for parental rearing styles.

Adolescent↗
PubMed1992

Depression and self-esteem: rapid screening for depression in black, low literacy, hospitalized tuberculosis patients.

One hundred black hospitalized tuberculosis (TB) patients (75 males and 25 females) were interviewed to ascertain levels of depression and self-esteem. The standard of literacy for 65% of the sample was such that they were unable to complete a self-report inventory. Reliability (internal consistency) was good for the 21-item Beck Depression Inventory (BDI: r = 0.79), the 13-item shortened BDI (ABDI: r = 0.76) and the Rosenberg Self-Esteem scale (RSE: r = 0.78). There was a significant positive relationship between the BDI and the ABDI (r = 0.92, P = 0.0001). The recommended ABDI cut-off scores established no depression for 32 patients, mild depression for 22 patients, moderate depression for 38 patients and severe depression for 8 patients. There were significant negative relationships between the BDI and the RSE (r = -0.54, P = 0.0001), and between the ABDI and the RSE (r = -0.56, P = 0.0001). Self-esteem scores dropped in accordance with category of depression, revealing that low self-esteem is a characteristic feature of depression. It was concluded that the ABDI was a reliable, rapid, initial screening device for depression in black persons with low literacy levels.

Adolescent↗
PubMed1988

Biorhythm of core temperature in depressive and non-depressive alcoholics.

Core temperature was longitudinally evaluated during the day- and nighttime in six non-depressive and in four depressive alcoholics who had been abstaining from alcoholic beverages. The least squares spectrum method was employed for detecting the periods and acrophase of the circadian rhythm of core temperature. Although normal periods were observed in all the patients throughout the study, an abnormal acrophase was found in many patients, especially in depressive alcoholics. On the 3rd and 4th days after alcohol withdrawal, all of the four depressive alcoholics showed a phase advance of the circadian rhythm, and three patients of the six non-depressive alcoholics exhibited an abnormal acrophase. On the 21st and 22nd days after alcohol withdrawal, a normal acrophase was observed in two patients of the four depressives and in four of the six non-depressives. The mean core temperature was higher in the depressives than in the non-depressives on the third and fourth days after alcohol withdrawal.

Adult↗
PubMed2006

Family heritage and depression guides: family and peer views influence adolescent attitudes about depression.

While adolescents tend to under-use professional mental health services for depression, they informally seek health-related information from parents and peers. In this study, we interviewed 15 adolescents to examine how the views and behaviours of others influence teens' decisions about seeking care for depression. Using a grounded theory approach, we found that teens' families, peers, and siblings contributed uniquely to teens' decisions in seeking care for depression. Families may disclose a "heritage" of depression, and their choices about disclosing family mental health issues, previous treatment, and coping strategies affected teens' understanding of depression. Peer "depression guides," who had themselves experienced depression, provided teens with advice on recognizing depression, managing stigma, and seeking care. Siblings bridged the roles of peer and family, influencing teens' choices about accessing treatment. These findings suggest that family and peers should be included during teens' depression treatment.

Adolescent↗
PubMed2004

Two overlooked mood disorders in women: subsyndromal depression and prenatal depression.

The purpose of this article is to assist nurses in developing a heightened sense of awareness about two often-overlooked types of mood disorders that can have a profound effect on women lives subsyndromal depression and prenatal depression. Subsyndromal depression can no longer be considered "minor" because we now understand the intense negative effect on many women's everyday lives. Screening for this disorder needs to be a routine part of care given to women in most health care environments. Simply helping women with subsyndromal depression to recognize that they may not feel sad or blue will create new opportunities for women to seek care when they are weighed down by symptoms such as sluggishness, foggy thinking, irritability, and food cravings. Nonpharmacologic interventions for subsyndromal depression dovetail with the holistic perspective that is the hallmark of nursing practice. Prenatal depression is a particularly hazardous condition because it isa "silent" form of depression that impacts women and their developing fetuses. It is often difficult to recognize against the backdrop of pregnancy and the tendency to blame emotional changes on pregnancy hormones. Practitioners must be aware of this phenomenon and take it seriously. Prenatal depression can have far-reaching effects if left untreated, impacting the pregnant woman and following that soon-to-be-born child through-out life in various detrimental ways. The pregnant woman who is laboring through the transitions of pregnancy and preparing to transition to the mother of a newborn baby should not be further burdened by the impact of depression.

Antidepressive Agents↗
PubMed2005

Serious diabetes-specific emotional problems and depression in a Croatian-Dutch-English Survey from the European Depression in Diabetes [EDID] Research Consortium.

It has been hypothesized that coverage of diabetes-specific issues (e.g. coping with complications, incapacity, pain) during psychotherapy may optimize the likelihood of treatment success for depression in patients with diabetes. However, it is still unclear how often depression is confounded by diabetes-specific emotional problems. We aim to determine the levels of diabetes-specific emotional problems in diabetic individuals with high versus low levels of depression in a sample of 539 outpatients with diabetes (202 Dutch, 185 Croatian and 152 English). Subjects completed the Center for Epidemiological Studies Depression and the Problem Areas in Diabetes scales. Percentages of patients with high depression scores were: 39 and 34% (Croatian men and women), 19 and 21% (Dutch men and women), 19 and 39% (English men and women). Moreover, 79% (Croatian), 47% (Dutch) and 41% (English) of the patients with a severe depression score reported to have four or more serious diabetes-specific emotional problems. For patients with low depression scores, these percentages were: 29% (Croatian), 11% (Dutch) and 1% (English). Serious diabetes-specific emotional problems are particularly prevalent in depressed diabetes patients. Randomized controlled trials are warranted to test whether coverage of diabetes-specific issues during psychotherapy can further improve the treatment of depression in diabetes.

Adult↗
PubMed2005

Prediction of depressive disorder following myocardial infarction data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT).

BACKGROUND: Depression following myocardial infarction (MI) is associated with complicated cardiac rehabilitation, non-compliance and poor prognosis. Whether depression following MI can be predicted from variables routinely assessed during hospitalization for MI is unknown. METHODS: Using data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT), we identified 2,177 MI patients (mean age 63 years; 23% female). Patients were randomly divided into a derivation and a validation sample. In the derivation sample, we analyzed variables potentially associated with the development of post-MI depressive disorder, which were tested in the validation sample. RESULTS: In the year following MI, 18.5% suffered from depressive disorder (ICD-10 criteria). In a multivariate model, factors associated with depression were younger age (OR 1.94; CI 1.38-2.74), hypercholesterolemia (OR 1.68; CI 1.08-2.61), the use of calcium channel blockers at discharge (OR 1.80; CI 1.20-2.71), and left ventricular ejection fraction (LVEF) (OR 4.14 for patients with LVEF <30%; CI (2.42-7.10). The derived predictors were tested in the validation sample. The final model yielded two clinical predictors, i.e., younger age and severe LV-dysfunction, which correctly predicted post-discharge depression status in 82.9% of the MI patients. The model yielded a high negative predictive value (89%). A positive depression questionnaire (BDI) during hospitalization increased the positive predictive value of 23% to 52%. CONCLUSIONS: During hospitalization for MI and using a two-step strategy with common clinical variables, i.e., younger age, severe LV-dysfunction and BDI score during hospitalization, it is possible to identify MI patients with a high risk for subsequent development of depression.

Adult↗
PubMed2004

Depression in older persons with versus without vascular disease in the open population: similar depressive symptom patterns, more disability.

BACKGROUND: Clinical studies suggest that vascular depression presents with typical symptom patterns. The aim of the present study is to examine whether depressed older persons in the open population with and without vascular disease show different symptom patterns. METHODS: In the Longitudinal Aging Study Amsterdam (LASA), a depressed cohort with (n=114) and without (n=292) vascular disease was identified. Depression was measured using self-reports (CES-D). Vascular disease was confirmed or ruled out using a combination of self-reported data, medication use and reports from general practitioners. RESULTS: No significant differences were found in depressive symptom patterns, in symptom clusters nor individual items of the CES-D. Depressed subjects with vascular disease showed much more disability than those without vascular disease. Age of onset of depression did not show statistically significant difference. CONCLUSIONS: From our study in the open population, there is no evidence to support the hypothesis that depressed older persons with vascular disease have a distinct depressive symptom profile, but they do show more disability.

Activities of Daily Living↗
PubMed2005

Clinical correlates of anxious depression among elderly patients with depression.

OBJECTIVE: The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression. METHODS: 352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination. RESULTS: The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms. CONCLUSION: In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.

Aged↗
PubMed2004

Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients.

Little is known about the effects of recurring depressive episodes on cognition and behavior. The objective of the study was to compare cognitive function and depression-related behavior between healthy female subjects and female outpatients with early-onset DSM-IV recurrent major depressive disorder and to investigate the effect of cumulative depressive duration. Neuropsychological tests and scales for apathy, anhedonia and psychomotor retardation were assessed in 23 female patients and 60 healthy age-matched female controls. Significantly higher levels of apathy, anhedonia and psychomotor retardation, and worse performance on tests of executive function were found in the patient group compared with the healthy controls. In the patient group, cumulative depression duration was not significantly correlated with cognitive function, apathy, anhedonia or psychomotor retardation. The deficits in executive function were not related to the actual level of depression. Mild executive dysfunction may be the effect of the illness process underlying recurrent depressive disorder. Repeated or extensive depressive episodes do not seem to additionally affect cognitive deficits or behavior in depressed patients.

Aged↗
PubMed2006

Difference in pre- and post-treatment plasma DHEA levels were significantly and positively correlated with difference in pre- and post-treatment Hamilton depression scores following successful therapy for major depression.

OBJECTIVE: Clinical studies of endogenous concentrations of dehydroepiandrosterone (DHEA) and its relation to depression are limited. This study examined whether pre- and post-treatment changes in plasma DHEA levels are correlated with pre- and post-treatment differences in Hamilton depression scores following successful antidepressant therapy for major depression with venlafaxine XR. METHOD: Thirty-four medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17, HAM-D 17 score > or = 17) were treated with antidepressants. At baseline, plasma DHEA levels of all subjects were measured but only those who remitted (HAM-D 17 score < or = 7) before the end of this study had their plasma DHEA levels measured at remission-onset. Blood from subjects was drawn at 0900-1100 h. Depression severity was assessed with the HAM-D 17 scale at baseline, and on day 7, 14, 28, 56 and 84. Subjects were administered at minimum 75 mg/day venlafaxine XR until remission onset. RESULTS: Fifteen patients remitted before the end of this study. Plasma DHEA levels decreased from baseline to remission was significant (P=0.017). After controlling for age and gender, pre- and post-treatment difference in Hamilton depression scores and the pre- and post-treatment difference in DHEA concentrations were significantly correlated (P=0.044). CONCLUSION: This preliminary study provides the first clinical evidence identifying that difference in pre- and post-treatment plasma DHEA levels were significantly and positively correlated with difference in pre- and post-treatment Hamilton depression scores following successful therapy with venlafaxine XR for major depression in remitters; but non-remitters were not examined. It is not known if DHEA levels would show similar or dissimilar changes in non-remitters.

Adolescent↗
PubMed1999

The differentiation of DSM-III-R psychotic depression in later life from nonpsychotic depression: comparisons of brain changes measured by multispectral analysis of magnetic resonance brain images, neuropsychological findings, and clinical features.

BACKGROUND: Psychotic depression has been proposed as a distinct subtype of major depression. There is considerable evidence for this in younger patients, although the neuroimaging has been rudimentary. Volumetric imaging studies are required of consecutive cohorts of patients with depression. METHODS: Ninety-nine consecutive elderly patients were diagnosed with DSM-III-R major depression. Eighteen were psychotic, and 81 were not. Sixty-six patients were given a neuropsychological test battery, and 44 had a magnetic resonance imaging brain scan. A model integrating clinical, psychological, and neuroimaging findings for the explanation of delusion formation during depression is proposed. RESULTS: Psychotic depression was characterized by worse physical health, more family history of depression, a poorer response to antidepressant drugs, and more severe lowering of mood; however, the strongest predictors of the presence of delusions were diencephalic atrophy, reticular activating system lesions, brain stem atrophy, and left-sided frontotemporal atrophy. The psychotic patients had poorer performance on tests of frontal lobe function and mental processing speed. CONCLUSIONS: In the elderly, psychotic depression is etiologically, clinically, and neuroradiologically distinct, and has different treatment requirements, from nonpsychotic major depression.

Age Factors↗
PubMed2000

Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire.

BACKGROUND: The emotional functioning (EF) dimension of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C33) and the Hospital Anxiety and Depression Scale (HADS) evaluate anxiety and depression. We wanted to compare cancer patients' responses to EF with those to HADS, as well as the impact of anxiety and depression on the quality of life (QL) dimensions of the EORTC QLQ C33. METHOD: A total of 568 cancer patients completed both the EORTC QLQ C33 and HADS at the same occasion. The association between the patients' EF scorings and their HADS scores was analyzed by multiple linear regression. Gender and age were included as covariates. RESULTS: Statistically significant negative relations were found between EF and HADS-A (anxiety), HADS-D (depression) and HADS-T (total score), respectively, with the highest correlation coefficient for HADS-A. Older patients and males reported less emotional distress assessed by the EF scale than younger ones and females with comparable HADS-T or HADS-D scores. Both HADS-A and HADS-D were significantly related to other QL dimensions, and depression was a stronger predictor for reduced QL than anxiety. CONCLUSION: The EF dimension of EORTC QLQ C33 predominantly assesses anxiety, whereas depression is rated to a lesser degree. Combined with significant age and gender relations, this implies a risk of underdiagnosed depression, if the EORTC QLQ C33 is used as the only instrument to screen for psychological distress in cancer patients. As depression has a stronger impact on global QL of cancer patients than anxiety, the use of an additional instrument is recommended for assessment of depression.

Adolescent↗
PubMed2001

Alexithymia and depression: a 1-year follow-up study in outpatients with major depression.

OBJECTIVE: To examine the changes in alexithymic features and depressive and other psychological distress symptoms during a 1-year follow-up among patients with major depression. METHODS: The study population comprised 120 outpatients suffering from major depression. Diagnosis was made with Structured Clinical Interview (SCID-I) for DSM-III-R. The severity of depression was evaluated with the 17-item Hamilton Rating Scale for Depression (HAM-D), and self-reported depression with the Beck Depression Inventory (BDI-21). Alexithymic features were assessed with the Twenty-Item Toronto Alexithymia Scale (TAS-20). Self-reported psychological distress symptoms were evaluated with the Brief Symptom Inventory (BSI). RESULTS: Measures of depression and distress were significantly lower at the follow-up than at the baseline, while the total TAS-20 scores did not change significantly during the follow-up. A closer examination revealed that various TAS-20 factors behaved differently. Changes in Factors 1 and 2 were associated with changes in mood, whereas those in Factor 3 were not. Additionally, recovery from depression was associated with decrease in alexithymic features. CONCLUSION: Difficulties in identifying and in describing feelings are associated with changes in mood, while externally oriented thinking is not.

Adolescent↗
PubMed2001

Anti-depressant prescribing patterns for prison inmates with depressive disorders.

BACKGROUND: Although prison inmates are reported to exhibit elevated rates of depressive disorders, little is known about anti-depressant prescribing patterns in correctional institutions. METHODS: The study population consisted of 5305 Texas Department of Criminal Justice (TDCJ) inmates who were diagnosed with one of three depressive disorders: major depression, dysthymia, and bipolar disorder (excluding those with manic episodes only). Information on medical conditions, sociodemographic factors, and pharmacotherapy was obtained from an institution-wide medical information system. RESULTS: In 1998, 78.2% of all inmates diagnosed with depressive disorders were treated with antidepressant medication. Of these, 47.3% were treated exclusively with tricyclic anti-depressants (TCA); 30.9% were treated with selective serotonin re-uptake inhibitors (SSRI); and 21.8% were not treated with any form of anti-depressant medication. Prescribing patterns varied substantially according to a number of sociodemographic factors under study. LIMITATIONS: Because the present study relied on retrospective, clinical data, the investigators had limited ability to assess: specific symptomatology for each diagnosed depressive condition under study; socio-economic status, pre-incarceration access to health care; and the overall reliability and validity of the data. CONCLUSION: The proportion of prison inmates with depressive disorders who receive appropriate medication management is substantially higher than that reported among similarly diagnosed nonincarcerated samples. It will be important, however, for future investigators to examine the sources of sociodemographic variation in treatment patterns found in the present study.

Adult↗