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PubMed2006

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms.

BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.

Adult↗
PubMed1999

Effects of depressed mood versus clinical depression on neuropsychological test performance among African American men impacted by HIV/AIDS.

The utility of self-report measures in identifying those at risk for depressive disorder and the adverse impact of depression versus depressed mood and HIV serostatus on neuropsychological (NP) test performance were examined in a large sample (N = 243) of gay and bisexual African American men. Results indicate high rates of depression relative to recent population estimates, regardless of methodology, but that the use of standard cut-scores for self-report inventories may significantly overestimate psychiatric morbidity. Limited independent effects of serostatus or depression on NP test performance were observed. More importantly, a complex set of adverse effects of depression and its interaction with serostatus which varied according to the methodology used to assess depression were observed. These findings are discussed in light of ongoing controversy regarding the relative influence of depression on neuropsychological functioning among people living with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Effects of adding cognitive therapy to fluoxetine dose increase on risk of relapse and residual depressive symptoms in continuation treatment of major depressive disorder.

Patients with major depressive disorder remain at risk for relapse following remission and often continue to experience subthreshold symptoms. This study compared the rate of relapse of major depressive disorder and the prevalence of residual depressive symptoms during the continuation phase for patients treated with fluoxetine dose increase alone or in combination with cognitive therapy. A total of 132 outpatients with major depressive disorder who achieved remission with 8 weeks of treatment with fluoxetine 20 mg had the dose increased to 40 mg. They were randomized to receive cognitive therapy or medication management alone and were followed for up to 28 weeks for depressive relapse and change in depressive symptoms. A total of 47 (35.6%) out of 132 patients did not complete the 28-week continuation phase. Rates of discontinuation or relapse did not differ significantly between the groups. Change in residual symptoms or wellbeing as measured by Hamilton Depression Scale score or Symptom Questionnaire self-report also did not differ between groups. In this sample of outpatients in continuation phase treatment for major depressive disorder, the combination of cognitive therapy and fluoxetine 40 mg failed to yield any significant benefit in symptoms or relapse rates over fluoxetine 40 mg alone during 28 weeks of follow-up.

Adult↗
PubMed1991

Life course of depressive illness and characteristics of current episode in patients with double depression.

It has been suggested recently that major depression and concurrent chronic minor depression, or "double depression" (DD), may have a different course and presentation from major depression alone (MDA). The present study compares 41 patients with DD and 60 patients with MDA for differences in life course of depressive illness and characteristics of the current depressive episode. Patients with DD, as compared with patients with MDA, had an earlier age of onset of mood disturbance, more episodes of major depression, and more frequent concurrent anxiety disorders. However, patients with DD were not significantly different from patients with MDA who had greater than a 6-month history of mood disturbance, with regard to life course of illness variable. The characteristics of current depression in patients with DD and MDA were not significantly different. The clinical and theoretical implications of these findings are discussed.

Adult↗
PubMed2006

Minor depression as a predictor of the first onset of major depressive disorder over a 15-year follow-up.

OBJECTIVE: To study the relationship of minor depression to first onset of major depressive disorder (MDD) among 1634 individuals over a 15-year follow-up using the Baltimore Epidemiologic Catchment Area cohort. METHOD: Logistic regression analyses were conducted with minor depression alone and also adjusting for anxiety, sociodemographic, and medical variables, with MDD as the outcome variable. Also, among those with minor depression, depressive symptom categories were studied with both logistic regression and population attributable risk (PAR) to determine if they predicted MDD. RESULTS: Individuals with a history of minor depression had an odds ratio of more than 5 of having a first lifetime episode of MDD (adjusted OR: 5.37, 95% CI: 2.87, 10.06). Suicidal ideation, appetite/weight issues, and sleep difficulty had the highest PARs. CONCLUSION: Minor depression strongly predicts MDD. Clinical and public health interventions for individuals with minor depression can potentially impact the pathway leading to MDD.

Adult↗
PubMed2025

ADHD in Youth With Major Depressive Disorder in the Texas Youth Depression and Suicide Research Network (TX-YDSRN): Clinical Correlates and Moderators.

OBJECTIVE: Depression is a major public health concern with a 19% lifetime prevalence in youth, often precipitating other concerns, including suicidal behavior, poor school performance, and worsened peer relationships. ADHD is also common among youth and frequently presents alongside major depressive disorder (MDD), with this comorbidity associated with increased impairment. More research is needed to elucidate the clinical characteristics of this comorbidity (MDD + ADHD), especially as it relates to youth with MDD and no ADHD (MDD - ADHD). The present study examined the clinical correlates of MDD + ADHD in youth and the presence of an ADHD diagnosis as a moderator of the relationship between depressive symptoms and suicidality, peer relationships, and school functioning, respectively. METHODS: Our sample included 797 youth with MDD ages 8 to 20 years (Mage = 15.5 years) with and without ADHD. RESULTS: Youth with MDD + ADHD experienced more severe depressive symptoms, higher levels of suicidality, impulsivity, and irritability, and worse academic performance compared to those with MDD - ADHD. ADHD diagnosis did not moderate the relationships between depression severity and suicidality, peer relationships, or school functioning, respectively, suggesting that having an ADHD diagnosis may not affect these outcomes in depressed youth in this way. CONCLUSION: Findings shed light on the impact of ADHD in depressed youth, which may allow for earlier and more tailored intervention efforts aimed at identifying and targeting depression, suicidality, peer relationships, and school functioning.

Humans↗
PubMed2000

Following depression in primary care: do family practice physicians ask about depression at different rates than internal medicine physicians?

OBJECTIVE: To determine whether the chronically or recurrently depressed patients of family practice and internal medicine physicians differed in the proportion reporting that their primary care physician asked them about depression symptoms. DESIGN: A cross-sectional observational study of chronically or recurrently depressed survey respondents who identified a family practice or internal medicine physician as their primary care provider. SETTING: A large not-for-profit group-model health maintenance organization in the northwestern United States, with a population representative of its service area. PATIENTS: Health maintenance organization members (n= 1161) with ongoing or recurring depression or dysthymia who responded to a 1993 survey and who identified either a family practice or internal medicine physician as their primary care provider. MAIN OUTCOME MEASURE: Patients' self-report of their primary care physician asking them: (1) whether they had been feeling sad, blue, or depressed; (2) to fill out a questionnaire about their mood or feelings; and (3) whether they had been thinking about death or suicide. RESULTS: Chronically or recurrently depressed patients of family practice physicians were more likely to report that their physician asked them about depressive symptoms than were patients of internal medicine physicians (34.0% vs 27.3%) (P=.02). This finding persisted in a multivariate analysis. CONCLUSION: Family practice physicians may be more attentive to depressive disorders than internal medicine physicians.

Cross-Sectional Studies↗
PubMed2000

Depression and diabetes: impact of depressive symptoms on adherence, function, and costs.

BACKGROUND: Depression is common among patients with chronic medical illness. We explored the impact of depressive symptoms in primary care patients with diabetes on diabetes self-care, adherence to medication regimens, functioning, and health care costs. METHODS: We administered a questionnaire to 367 patients with types 1 and 2 diabetes from 2 health maintenance organization primary care clinics to obtain data on demographics, depressive symptoms, diabetes knowledge, functioning, and diabetes self-care. On the basis of automated data, we measured medical comorbidity, health care costs, glycosylated hemoglobin (HbA(1c)) levels, and oral hypoglycemic prescription refills. Using depressive symptom severity tertiles (low, medium, or high), we performed regression analyses to determine the impact of depressive symptoms on adherence to diabetes self-care and oral hypoglycemic regimens, HbA(1c) levels, functional impairment, and health care costs. RESULTS: Compared with patients in the low-severity depression symptom tertile, those in the medium- and high-severity tertiles were significantly less adherent to dietary recommendations. Patients in the high-severity tertile were significantly distinct from those in the low-severity tertile by having a higher percentage of days in nonadherence to oral hypoglycemic regimens (15% vs 7%); poorer physical and mental functioning; greater probability of having any emergency department, primary care, specialty care, medical inpatient, and mental health costs; and among users of health care within categories, higher primary (51% higher), ambulatory (75% higher), and total health care costs (86% higher). CONCLUSIONS: Depressive symptom severity is associated with poorer diet and medication regimen adherence, functional impairment, and higher health care costs in primary care diabetic patients. Further studies testing the effectiveness and cost-effectiveness of enhanced models of care of diabetic patients with depression are needed. Arch Intern Med. 2000;160:3278-3285.

Adult↗
PubMed1984

Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression.

As part of a longitudinal nosologic study of major depressive disorder, dysthymic disorder (DD), and adjustment disorder with depressed mood ( ADDM ) in a school-aged cohort, the predictive validity of each diagnosis was examined. Using all available data on the course of the disorders, the criterion was the first subsequent major depressive episode. Major depressive disorder and DD signaled a similarly high risk of a new bout of depressive illness. For the children who recovered from their first episode of major depression and then had their second one (40%), the free interval did not exceed two years; an underlying dysthymia increased the risk of recurrence. Major depression and dysthymia were distinct from ADDM and a set of control disorders; the latter two diagnostic groups were associated with a minimal risk for major depression.

Adjustment Disorders↗
PubMed1987

Children of depressed parents. Increased psychopathology and early onset of major depression.

Data on the psychiatric diagnosis, overall functioning, and treatment of 220 6- to 23-year-old subjects who were at high or low risk for major depression are presented. The subjects' diagnoses were made by a child psychiatrist based on best-estimate evaluation of diagnostic information derived from structured interviews (Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Epidemiologic Version) with the subjects and separately with their mothers about their children. The major findings were an increased overall prevalence of major depression and substance abuse, psychiatric treatment, poor social functioning, and school problems in the children of depressed proband parents compared with children of normal proband parents. Overall prepubertal depression was uncommon and the sex ratios were equal. After 12 years of age, there was an increasing preponderance of female subjects in the group with major depression. The mean age at onset of major depression was similar for male and female subjects. However, it was significantly earlier in the children of depressed probands (mean age at onset, 12 to 13 years) compared with the children of normal probands (mean age at onset, 16 to 17 years). Symptom profiles and additional types of diagnoses in the depressed children from either proband parent group did not differ. These children are being followed up longitudinally to determine the prognostic significance, persistence, recurrence, and recall of their symptoms. Several research and clinical strategies are suggested by these data.

Adolescent↗
PubMed1990

Major depressive disorder, alcoholism, and reduced natural killer cell cytotoxicity. Role of severity of depressive symptoms and alcohol consumption.

Depression and alcohol abuse have been associated with alterations in cell-mediated immune function. This study directly compared the effects of depression, alcoholism, and their joint contribution to reduce natural killer cell cytotoxicity. Natural killer cell activity was significantly lower in both depressed (n = 18) and alcoholic (n = 19) patients compared with control subjects (n = 50). In addition, patients with a dual diagnosis of either alcohol abuse and secondary depression (n = 9) or depression with a history of alcohol abuse (n = 26) demonstrated a further decrease in natural killer cell activity compared with that found in patients with either depression or alcoholism alone. While both depression and alcoholism are separately associated with a reduction of natural killer cell activity, subgroups of patients in whom the diagnoses of alcoholism and depression coexist show a further decrement in natural killer cell function.

Adult↗
PubMed1996

Convergent validity of the Depression-Happiness Scale with measures of depression.

In recent years, the study of subjective well-being (SWB) has attracted much research interest. One recent operational definition of SWB is the McGreal and Joseph (1993) Depression-Happiness Scale. The aim of the present research was to investigate the convergent validity of the Depression-Happiness Scale with several other well established measures of depressive symptomatology. Subjects were 194 undergraduate students attending the University of Ulster. Lower scores on the Depression-Happiness Scale, indicating a higher frequency of negative thoughts and feelings and a lower frequency of positive thoughts and feelings, were associated with higher scores on the Beck Depression Inventory, the Self-Rating Depression Scale, and the Center for Epidemiological Studies Depression Scale. These data provide further evidence for the convergent validity of the Depression-Happiness Scale.

Adolescent↗
PubMed1981

Depression and self-esteem: an investigation that used behavioral and cognitive approaches to the treatment of clinically depressed clients.

Investigated the relative effectiveness of the behavioral and cognitive approaches to the treatment of depression using clinically depressed clients and the relationship between self-esteem and depression before and after treatment. Sixteen depressed patients matched for sex, age, and levels of depression were involved. Ss were assigned to either the cognitive or the behavioral treatment groups. Three weeks' baseline followed by 8 weeks' treatment programme was given to Ss in each group. The results of the statistical analysis show that both treatment groups are effective in alleviating depression, but the cognitive treatment group improved at a faster rate than the behavioral group. No significant correlation between self-esteem and depression was observed at baseline. However, a significant inverse correlation was observed at posttreatment and follow-up. The findings showed that both behavioral and cognitive approaches were effective in the treatment of depression. However, the cognitive approach was slightly better than the behavioral approach.

Adult↗
PubMed1985

Affective disorders and depression as measured by the Diagnostic Interview Schedule and the Beck Depression Inventory in an unselected adult population.

Rates, demographic correlates, and differential symptomatic expression as a function of gender of affective disorders and depression as measured by the Diagnostic Interview Schedule (DIS) and the Beck Depression Inventory (BDI) were examined in 298 paid adult volunteers selected by the random digit dialing method. According to the DIS, 7.7% were diagnosed as current affective disorder, 6% as current primary unipolar depression, 23.5% as lifetime affective disorder, and 19.5% as lifetime primary unipolar depression. According to the BDI, 19.8% scored depressed: 10.7% as mildly, 5.0% moderately, and 4.0% severely depressed, respectively. Of 11 demographic variables whose relation to DIS diagnoses were examined in a multivariate context, only occupation was correlated significantly with current primary unipolar depression. Of the same variables whose relation to BDI score was examined, education and race were correlated significantly with BDI score. There was no evidence of differential symptomatic expression as a function of gender as measured by lifetime diagnosis of primary unipolar depression on the DIS.

Adolescent↗
PubMed2000

Depressive realism: effects of depression severity and interpretation time.

This study examined the theory of depressive realism, which posits that depressed people often are more accurate in perceptions and judgments than nondepressed people. Two possible qualifications to this theory were examined: (1) severity of depression moderates the effect, and (2) length of processing time will impact the presence of bias in depressed people, that is, negative bias will develop over time. College students were presented with a bogus personality profile that actually consisted of items previously rated as neutral in desirability. Participants rated these profiles for desirability initially and then again three days later. Results indicated a significant effect of depression severity on desirability rating. Nondepressed and mildly depressed students found their profiles to be more positive than the moderately/severely depressed students, with both groups having scores in the positive range. However, those participants who were moderately/severely depressed showed a negative bias in their ratings. No support was found for the effect of different times of interpretation.

Adult↗
PubMed2003

Assessment of depression in rheumatoid arthritis: a modified version of the center for epidemiologic studies depression scale.

OBJECTIVE: The Center for Epidemiologic Studies Depression Scale (CES-D) is an instrument commonly used to assess depressive symptoms. Although the psychometric properties of the instrument are well established, the instrument's ability to identify confirmed cases of major depression has been unclear. The purpose of this study was to evaluate the ability of cutoff scores from both a full scale and a modified CES-D to detect major depression in people with rheumatoid arthritis (RA). METHOD: Data were analyzed from 457 persons with RA, including 91 who met criteria for major depression. RESULTS: Results indicated that, in general, a full scale cutoff score of 19 was the most efficient in identifying cases of major depression; the cutoff score of 19 outperformed a variety of other cutoff scores from the modified scale. Even the most efficient cutoff scores, however, demonstrated problems in accurately identifying people with depression. CONCLUSION: The CES-D, while potentially useful as a screening tool, should not be used to identify cases of major depression.

Arthritis, Rheumatoid↗
PubMed2005

Venlafaxine in the treatment of depressive and vasomotor symptoms in women with perimenopausal depression.

Perimenopause is often marked by vasomotor symptoms and dysphoria. Antidepressant studies have demonstrated decreased frequency and severity of hot flashes in breast cancer survivors and menopausal women. We hypothesized that venlafaxine would relieve both depressive and vasomotor symptoms in depressed perimenopausal women. Sixteen women fulfilling clinical criteria for climacteric phase and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for a depressive episode were enrolled in an open-label 8-week trial of extended-release venlafaxine. Depressive and climacteric symptoms were monitored using the Hamilton Rating Scales for Depression (Ham-D) and Anxiety (Ham-A), Clinical Global Impression (CGI) scale, and Greene Climacteric Scale (GCS). Serum follicular stimulating hormone (FSH) and estradiol concentrations were monitored. Significant decreases in Ham-D and Ham-A scores and the GCS psychiatric subscale were seen after 2 weeks of treatment. In an intention-to-treat analysis, 81% of the subjects demonstrated a therapeutic antidepressant response (>50% decline in Ham-D score) and 75% achieved clinical remission (Ham-D score < or =7) after 8 weeks of venlafaxine therapy (75-225 mg/day). Total GCS scores declined 60%, and GCS vasomotor subscores decreased among those with vasomotor symptoms at baseline. These data suggest that venlafaxine treatment improves overall well-being, reduces depressive symptoms, and may diminish baseline vasomotor symptoms in depressed perimenopausal women. Further studies are warranted to investigate the utility of venlafaxine in perimenopausal depression.

Adult↗
PubMed2006

Nonverbal behavioral similarity between patients with depression in remission and interviewers in relation to satisfaction and recurrence of depression.

Unsatisfying interpersonal relationships are involved in the onset and course of depression. However, little is known about the underlying mechanisms. In this study we investigated the nonverbal communication between 101 patients with remitted depression and interviewers. We related the interaction between the patients' and interviewers' behavior to patients' satisfaction with the interview and to the risk of recurrence of depression. We registered the patients' and interviewers' nonverbal displays of involvement during a clinical interview and assessed the patients' satisfaction with the interview. Possible recurrence of depression was assessed within a 2-year follow-up. Based on findings in healthy people, we hypothesized that the more similar the levels of the patients' and interviewers' behavior became during the interview, the more satisfied the patients would turn out to be. Furthermore, we hypothesized that lack of similarity in the levels of the patients' and interviewers' involvement behavior would predict recurrence of depression. Our hypotheses were confirmed: The more the patients' and interviewers' behavior converged, the more satisfied the patients were with the interview and the lower the risk of recurrence of depression. Satisfaction did not mediate the association between convergence and risk of recurrence. Also, no gender effects were found. We conclude that nonverbal communication processes are involved in the risk of recurrence of depression. Remitted people's difficulties in reaching nonverbal convergence with others may hamper them in their interpersonal functioning and, as a consequence, may put them at risk for new episodes of depression.

Adult↗