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PubMed2003

The Depression-Arkansas scale: A validation study of a new brief depression scale in an HMO.

Recent trends in mental-health care have increased the need for practical depression instruments. The Depression-Arkansas (D-ARK), a brief, economical, multipurpose instrument, has been validated for assessing major depressive disorder (MDD) and depressive-symptom severity. Psychometric properties of the D-ARK were compared with standard depression scales (Beck Depression Inventory and Geriatric Depression Scale) among 294 adult and 193 senior primary-care patients, respectively, and 163 patients enrolled in cognitive-behavioral depression classes. The severity scale displayed adequate internal reliability (coefficient alpha =.81-.86), high correlation with the BDI-2 (r =.78-.83) and GDS (r =.75), and similar factor structure to the BDI-2. The D-ARK was calibrated against the BDI-2 and GDS, providing familiar severity category cutpoints with the new instrument. This study yields further data supporting the reliability, validity, and practical utility of the D-ARK.

Adult↗
PubMed2004

The Diagnostic Inventory for Depression: a self-report scale to diagnose DSM-IV major depressive disorder.

In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we describe the development and validation of the Diagnostic Inventory for Depression (DID), a new self-report scale designed to assess the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) symptom inclusion criteria for a major depressive episode, assess psychosocial impairment due to depression, and evaluate subjective quality of life. A large sample of 626 psychiatric outpatients completed the DID and were interviewed with the Structured Clinical Interview for DSM-IV (SCID). The measure's test-retest reliability, discriminant and convergent validity, and sensitivity to clinical change were investigated. The DID subscales achieved high levels of internal consistency and test-retest reliability. The DID was more highly correlated with another self-report measure of depression than with measures of anxiety, substance use problems, eating disorders, and somatization, thereby supporting the convergent and discriminant validity of the scale. The DID also was highly correlated with interviewer ratings of the severity of depression and psychosocial functioning, and DID symptom severity scores were significantly different in depressed patients with mild, moderate, and severe levels of depression. The DID was a valid measure of symptom change. Finally, the DID was significantly associated with a diagnosis of major depressive disorder.

Adolescent↗
PubMed2004

Prognostic value of depressive coping and depression in survival of lung cancer patients.

The aim of this investigation was to determine whether depressive coping and depression predict shorter survival among lung cancer patients. We conducted a prospective study using an inception cohort with a 3-5-year follow-up. The sample consisted of n = 59 (of n = 69 invited to participate) patients (mean age 65 years, S.D. = 9.7; 81% male) newly diagnosed with small cell lung cancer or non-small cell lung cancer Stage III or IV who were scheduled for later chemotherapy and/or radiotherapy at a tertiary care centre. Patients were investigated after their diagnosis and before the beginning of treatment. Depressive coping and depression were assessed using standardized self-report questionnaires (Freiburg Questionnaire of Coping with Illness; Hospital Anxiety and Depression Scale). Depressive coping was associated with shorter survival (hazard ratio 1.75, 95% confidence interval 1.04-2.93, p = 0.034) after adjusting for age, sex, stage, histological classification, and Karnofsky performance status but not treatment type, using the Cox proportional hazards regression. Depression, however, was not linked with survival (hazard ratio 1.05, 95% confidence interval 0.98-1.13, p = 0.18). To conclude, the prognostic value of depressive coping was partially confirmed, warranting further examination of the robustness of this relationship.

Adaptation, Psychological↗
PubMed1991

Characteristics of depressed and non-depressed children and their parents.

A sample of 186 outpatient children considered by both clinicians and parents as depressed or non-depressed were compared in terms of child and parent variables. Parents of depressed children appeared to be more overinvolved with their children, more overprotective, more likely to have communication difficulties in the family and more apt to undermine the child's learning. More girls were depressed than boys and depressed children exhibited more somatic complaints and coexisting phobic or anxiety disorders. The results of the present study need to be replicated with a broader group of depressed and non-depressed children and their families from other regions of the country. Further research in this area is indicated in order to provide clinicians who work with depressed children with a better understanding of their symptoms and parental characteristics.

Adolescent↗
PubMed2004

Is depressive mixed state a transition between depression and hypomania?

BACKGROUND: Depressive mixed states (DMX), described systematically by Kraepelin, have recently been found common among depressed outpatients, with possible important impact on treatment. Study aim was to find if DMX in bipolar II disorder was often a transition period between depression and hypomania, as suggested by Kraepelin. METHODS: 194 consecutive bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. Hypomanic symptoms during the index MDE were systematically assessed. DMX was defined as a MDE plus > 2 hypomanic symptoms appearing during the MDE (not before it), following Akiskal and Benazzi (2003). History of depression-hypomania cycles and vice versa (without symptom-free intervals) was assessed. If DMX were a transition period, cycles should have been more common in bipolar II with DMX than in bipolar II without DMX. To test if there were differences between DMX with history of cycles and DMX without history of cycles, the two subgroups were compared on many clinical, family history, and temperamental variables. To test if there were differences between bipolar II with DMX and bipolar II without DMX, comparisons between the two subgroups were done on variables often reported to be typically found in bipolar disorders and to be diagnostic validators (young onset, many recurrences, atypical features of depression, bipolar family history, temperamental mood lability, gender). RESULTS: DMX was present in 70.1%, and history of cycles in 79.8%. In bipolar II without index DMX (n = 58) history of cycles was present in 86.2%; in bipolar with index DMX (n = 136) history of cycles was present in 77.2% (p = 0.175). DMX with cycles was not significantly different from DMX without cycles on all study variables (apart from agitation). Bipolar II with index DMX, versus bipolar II MDE without index DMX, had significantly more depressions with atypical features, temperamental mood lability, and more females, while age of onset, recurrences, and bipolar family history were not significantly different. LIMITATIONS: Single interviewer, cross-sectional assessment. CONCLUSIONS: Findings do not support Kraepelin's view of DMX as a transition period between depression and hypomania, and a distinction between DMX with and without cycles. Findings only partly support DMX as a distinct subtype of bipolar II, which seems to require temperamental mood lability for its onset during a bipolar II MDE.

Adult↗
PubMed2006

A partner-rating scale of postpartum depression: the Edinburgh Postnatal Depression Scale - Partner (EPDS-P).

Partners could be useful as informants of postpartum women's depressive symptoms; however, currently no partner-ratings exist. The Edinburgh Postnatal Depression Scale - Partner (EPDS-P) is a 10-item measure adapted from the Edinburgh Postnatal Depression Scale (EPDS). The EPDS-P is expected to converge with the EPDS and other measures of depressive symptoms and to demonstrate incremental validity in the prediction of depressive symptoms. 101 women and their partners completed multiple measures of depressive symptoms during the first six weeks postpartum. Initial results suggest adequate reliability and validity for the EPDS-P. The EPDS-P showed moderate convergent correlations with other depression measures. Longitudinal correlations showed a link between the two-week EPDS-P and the six-week EPDS. The EPDS-P demonstrated incremental validity over and above the EPDS. Results supported the use of the EPDS-P as a valid partner-rating scale. The findings confirm that partners of postpartum women are valuable resources when assessing depressive symptoms.

Adult↗
PubMed1994

Depressive mania versus agitated depression: biogenic amine and hypothalamic-pituitary-adrenocortical function.

The existence of mixed affective states challenges the idea of specific biological abnormalities in depression and mania. We compared biogenic amines and hypothalamic-pituitary-adrenocortical (HPA) function in mixed manic (n = 8), pure manic (n = 11), agitated bipolar depressed (n = 20), and nonagitated bipolar depressed (n = 27) inpatients (Research Diagnostic Criteria). Mixed manics met Research Diagnostic Criteria for primary manic episodes and also met criteria for major depressive episodes except for duration. The norepinephrine metabolite methoxyhydroxy phenthylene glycol (MHPG) was higher in cerebrospinal fluid from mixed manic than from agitated depressed patients, consistent with differences previously reported between the overall samples of depressed and manic patients. Similarly, patients in a mixed state had higher urinary excretion of norepinephrine (NE) and elevated output of NE relative to its metabolites. HPA activity was similar in mixed manic and agitated depressed patients. These data suggest that mixed manics combine certain biological abnormalities considered to be characteristic of mania and of depression.

Adult↗
PubMed1996

Concise assessment for depression (CAD): a brief screening approach to depression in the medically ill.

Diagnosis of depression in the medically ill is problematic because many of the symptoms used for diagnosis, such as poor sleep and poor appetite, may be due to the underlying physical illness. The aim of the present study was to validate a brief measuring instrument, the concise assessment for depression (CAD), designed to accurately diagnose major depressive disorders in medically ill patients. The CAD was validated against DSM-IV and ICD-10 diagnostic criteria, as well as against modified DSM-IV diagnostic criteria that excluded somatic items. The modified DSM-IV diagnostic criteria have previously been suggested as the most appropriate to use in the medically ill. The effectiveness of the CAD was also compared to the Hospital Anxiety and Depression scale (HAD), a questionnaire widely used to determine the presence of depression in the medically ill. Diagnoses were obtained using a new semistructured psychiatric interview, the Schedules for assessment in Neuropsychiatry (SCAN). A total of 313 consecutive acute medical admissions were interviewed on the 7th day of admission. The first 153 patients also completed the HAD. Using the modified DSM-IV criteria 18 (5.1%) of the patients were diagnosed as having a major depressive disorder. Using a cut-off point of 3, the sensitivity of the CAD for major depressive disorder was 100%, the specificity was 99%, and the positive predictive value was 86%. This compared favorably with the HAD, in which the sensitivity was 78%, the specificity was 77%, and the positive predictive value was 18% using the most favorable cut-off point. The results from the present study thus validate the CAD to be effective in accurately diagnosing major depressive disorder in the medically ill.

Adult↗
PubMed1984

Life events and depression. Part 2. Results in diagnostic subgroups, and in relation to the recurrence of depression.

Although there is evidence that the occurrence of stressful life events might be important for the onset and development of depression, it is still unclear whether differences occur in diagnostic subgroups of depressed patients, or in relation to type of episode, i.e., whether the first event or a relapse in a depression with a recurrent course. The present study has been carried out to investigate these issues more closely. Two hundred and six depressed patients have been classified into bipolar, unipolar, neurotic-reactive, and unspecified subgroups according to given definitions. The patients have also been classified into those suffering from a first episode and those suffering from recurrent depression. Each patient, when sufficiently improved, was given a semistructured interview, based on a specially constructed 56-item life events inventory. Unipolar and bipolar patients proved to have experienced significantly fewer events, even of the 'fateful' type (i.e., independent of depression) than the neurotic-reactive patients. However, this difference appeared to be due to difference in age among the groups and not to diagnosis. No difference occurred between uni- and bipolar patients. Patients with recurrent depression showed only small differences compared with patients in their first episode. These differences were consistently in the direction of fewer events in patients with recurrent depression. The implications of these results are discussed in relation to findings published by other authors.

Adjustment Disorders↗
PubMedDate not supplied

Rating depression in normals and depressives: observer versus self-rating scales.

Different methods of assessing depression and anxiety were tested in 20 patients suffering from a major depressive disorder with melancholia and 20 matched control subjects. Depressives were assessed before and after treatment with amitriptyline and normals were retested at the same interval. The scales used were: Paykel's Clinical Interview for Depression--which is an expanded version of the Hamilton Depression Rating Scale; the Brief Depression Rating Scale; and Symptom Questionnaire (SQ). All scales discriminated sensitively between patients and normals and the scores changed substantially with treatment. Except for the well-being subscales of the SQ, the scales showed an adequate test-retest reliability in normals. Although all scales were suitable for the measurement of depression, they differed in psychometric properties. For example, the Depression subscale of the SQ showed an unusually high test-retest reliability in normals, whereas the Contentment subscale was unreliable. Yet, the latter has been found to be highly sensitive in detecting differences between the effects of psychotropic drugs and placebo in drug trials, so it appears to measure sensitively a fleeting mood. The combined use of all three scales in patients with affective disorders yields information that might not be revealed if only one scale is used.

Adult↗
PubMed1982

Verbal interaction patterns of depressed and non-depressed institutionalized mentally retarded adults.

Data obtained through 18, 5-minute observations of nine depressed and nine nondepressed institutionalized mentally retarded adults revealed five patterns of verbal interaction including: (a) other individuals were more likely to request action from depressed individuals than to make declarative statements; (b) the depressed subjects were more likely to gain compliance by exhibiting negative affect; (c) the depressed subjects were more likely to resist request by exhibiting negative affect; (d) other individuals were more likely to exhibit negative affect when interacting with depressed subjects; (e) staff rather than peers were more likely to interact with depressed subject. Depressed and non-depressed subjects could not be differentiated by the number of communications initiated which did not require a response from others and on the percentage of communications initiated with staff.

Adult↗
PubMedDate not supplied

Substance use disorder comorbidity in major depressive disorder: an exploratory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort.

Patients with major depressive disorder (MDD) often present with concurrent substance use disorders (SUD) involving alcohol and/or illicit drugs. This analysis compares the depressive symptomatic presentation and a range of clinical and demographic features of patients with MDD and concurrent SUD symptoms vs those without SUD symptoms, to clarify how these two differ and to determine whether concurrent SUD symptoms may alter the clinical presentation of MDD. The first 1500 outpatients with nonpsychotic MDD enrolled in the Sequenced Treatment Alternatives to Relieve Depression study were divided into those with and without concurrent SUD symptoms as ascertained by a self-report instrument, the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Of the 1484 cases with completed baseline PDSQ, 28% (n = 419) of patients with MDD were found to endorse symptoms consistent with current SUD. Patients with symptoms consistent with SUD were more likely to be men (P < .0001), to be either divorced or never married (P = .018), to have a younger age of onset of depression (P = .014), and to have a higher rate of previous suicide attempts (P = .014) than those without SUD symptoms. Patients with major depressive disorder who have symptoms consistent with SUD endorsed greater functional impairment attributable to their illness than those without concurrent SUD symptoms (P = .0111). The presence of SUD symptoms did not alter the overall depressive symptom pattern of presentation, except that the dual-diagnosed patients had higher levels of hypersomnia (P = .006), anxious mood (P = .047), and suicidal ideation (P = .036) compared to those without SUD symptoms. In conclusion, gender, marital status, age of onset of major depression, functional impairment, and suicide risk factors differ in depressed patients with concurrent SUD symptoms compared to those without SUD comorbidity.

Adult↗
PubMedDate not supplied

Validity of a self-report depression symptom scale for identifying remission in depressed outpatients.

In treatment studies of depression, remission is usually defined by scoring less than a threshold value on an interview-based measure of depression severity such as the Hamilton Rating Scale for Depression (HRSD). Although it has been recommended that measures such as the HRSD be used by clinicians in clinical practice to evaluate remission status, the time demands of clinical practice limit the feasibility of this suggestion. Self-report questionnaires are a cost-effective option to thoroughly, systematically, reliably, and validly evaluate clinical status because they are inexpensive in terms of professional time needed for administration and do not require special training for administration. In a previous report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we derived a cutoff on a self-report depression questionnaire corresponding to the widely used definition of remission on the HRSD (ie, < or = 7). In the present report, we examined the validity of this questionnaire as an indicator of remission among patients who responded to antidepressant treatment. Specifically, we examined psychosocial functioning in treatment responders who were and were not in remission according to the self-report symptom scale. In a sample of 371 depressed outpatients who were judged by their treating psychiatrists as having responded to treatment, 250 scored in the remission range on the symptom scale. Compared with treatment responders whose depression was not in remission, the patients who were in remission reported significantly less psychosocial impairment and significantly better quality of life and were significantly more likely to assert that they are in remission from their depression. These findings support the validity of a self-report depression questionnaire as an index of remission status among treatment responders.

Adult↗
PubMed2006

Withdrawn and intrusive maternal interaction style and infant frontal EEG asymmetry shifts in infants of depressed and non-depressed mothers.

The effects of maternal interaction style (intrusive/withdrawn) on the development of brain electrical activity were studied in infants of depressed and non-depressed mothers shortly after birth and again at 3-6 months of age. Infants of depressed mothers exhibited significantly greater relative right frontal EEG activation than infants of non-depressed mothers. Infants of depressed withdrawn mothers exhibited greater relative right frontal EEG activation than infants of depressed intrusive mothers. Furthermore, while infants of depressed mothers with intrusive interaction styles showed a shift towards greater relative left frontal EEG activation from birth to 3-6 months, infants of depressed mothers with withdrawn interaction styles showed a shift towards greater relative right frontal EEG activation.

Brain↗
PubMed2006

Instrumental and vocal music effects on EEG and EKG in neonates of depressed and non-depressed mothers.

Neonates (M age=16 days) born to depressed and non-depressed mothers were randomly assigned to hear an audiotaped lullaby of instrumental music with vocals or without vocals. Neonatal EEG and EKG were recorded for 2min (baseline) of silence and for 2min of one or the other music presentation. Neonates of non-depressed mothers showed greater relative right frontal EEG asymmetry to both types of music, suggesting a withdrawal response. Neonates of depressed mothers on the other hand showed greater relative left frontal EEG asymmetry to the instrumental without vocal segment, suggesting an approach response, and greater relative right frontal EEG asymmetry to the instrumental with vocal segment, suggesting a withdrawal response. Heart rate decelerations occurred following the music onset for both groups of infants, however, compared to infants of non-depressed mothers, infants of depressed mothers showed a delayed heart rate deceleration, suggesting slower processing and/or delayed attention. These findings suggest that neonates of depressed and non-depressed mothers show different EKG and EEG responses to instrumental music with versus without vocals.

Adult↗
PubMed2006

Return of depressed men: changes in distribution of depression and symptom cases in Norway between 1990 and 2001.

BACKGROUND: Women's elevated risk of depression compared to men is a common finding in psychiatric epidemiology. Studies conducted in the 1950s and 1970s, however, documented approximately equal prevalence of sex rates. AIM: This study investigated changes in depression rates between 1990 and 2001 in Norway. Further, differences in severity were examined between men and women. METHOD: A study population (later to be called OsLof) was established in 1990, supplemented in 2001, and analysed as two cross-sectional datasets to compare sex and age differences in ICD-10 diagnoses and HSCL-25> or =1.75 caseness. Organic depression and the DSM-IV Major Depressive Episode were also examined in 2001. RESULTS: There was no significant change in the prevalence of depression or HSCL-25 caseness from 1990 to 2001. However, a major shift in prevalence occurred over time within the 18-34 year old age category with significantly higher rates among younger men (1% to 10%) and lowered rates among younger women (10% to 4%). Among persons depressed, no significant differences were found for severity between the sexes. LIMITATIONS: A selection of healthier participants than found in the source population might have resulted in lower prevalence than real. CONCLUSION: There was no indication of an overall increase in depression from 1990 to 2001, neither by diagnosis nor by symptom checklist scores. However, a major shift in prevalence occurred within the 18-34 year old age category with significantly higher rates among younger men and lowered rates among younger women. No sex differences existed in terms of severity of depression.

Adolescent↗
PubMed2006

Quality of life and depressive symptoms in patients with major depression and end-stage renal disease: a matched-pair study.

OBJECTIVE: To compare the quality of life (QOL) and depressive symptoms of outpatients with major depression with that of nondepressed individuals undergoing hemodialysis (matched for age, gender, and ethnicity). METHODS: We used the WHOQOL BREF and the Beck Depression Inventory (BDI). RESULTS: After univariate analyses, depressed patients' QOL scores were significantly lower (P<.0001) in all the assessed domains (i.e., physical health, psychological, social relationships, environmental, and global QOL). Additionally, there was a significant difference in the severity of depression among the study groups (P<.0001). Finally, after multiple regression analysis, the QOL profile of depressed subjects remained significantly worse even when controlling for depression scores and diagnostic status. CONCLUSION: The subjective QOL of patients with major depression is significantly lower than that of subjects undergoing hemodialysis.

Adolescent↗
PubMed2003

Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression.

Several studies have shown that major depression is accompanied by alterations in serum fatty acid composition, e.g. reduced n-3 fatty acids and an increased 20:4n-6/20:5n-3 ratio in serum. Moreover, pregnancy leads to depletion of maternal serum 22:6n-3 and after delivery maternal serum 22:6n-3 steadily declines further. Therefore, the aim of the present study was to investigate whether the postpartum fatty acid profile of maternal serum phospholipids (PL) and cholesteryl esters (CE) differs in women who develop postpartum depression compared to controls. We compared the fatty acid composition shortly after delivery of 10 women who developed postpartum depression and 38 women who did not. After delivery, 22:6n-3 and the sum of the n-3 fatty acids in PL and CE was significantly lower in the group of mothers who developed a postpartum depression. The ratio of Sigman-6/Sigman-3 fatty acids in PL was, postpartum, significantly higher in the depressed group as compared to the controls. The abnormalities in fatty acid status previously observed in major depression are now also confirmed in postpartum depression. These results indicate that pregnant women who are at risk to develop postpartum depression may benefit from a prophylactic treatment with n-3 PUFAs, such as a combination of 20:5n-3 and 22:6n-3.

Cholesterol Esters↗