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PubMed1991

A family study of DSM-III-R schizoaffective disorder, depressive type, compared with schizophrenia and psychotic and nonpsychotic major depression.

OBJECTIVE: To assess the validity of DSM-III-R schizoaffective disorder, the authors explored the morbid risks for schizophrenia and major affective disorders in the first-degree relatives of patients with schizoaffective disorder and relevant other diagnoses. METHOD: In addition to patients with DSM-III-R schizoaffective disorder, depressive type (N = 21), the probands included patients with mood-incongruent psychotic depression (N = 22), mood-congruent psychotic depression (N = 19), nonpsychotic depression (N = 27), or schizophrenia (N = 28) and normal subjects (N = 18). The patients were consecutively recruited from the outpatient facilities of a university psychiatry department; the normal subjects were students and nurses. All probands were directly interviewed, with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version (SADS-L), by a psychiatrist blind to information about relatives. Consenting relatives were directly interviewed, with the SADS-L, by two psychiatrists blind to the probands' diagnoses. The direct interview was supplemented--or replaced, when an interview was not possible (24%)--by family history data from all available sources. Morbid risks in relatives were calculated according to the Weinberg method. RESULTS: The relatives of the schizoaffective patients had almost the same risk for schizophrenia as the relatives of the schizophrenic patients. In the relatives of the patients mood-incongruent psychotic depression, the morbid risk for major affective disorders was about one-half that of the relatives of the patients with mood-congruent psychotic depression and one-third that of the relatives of the patients with nonpsychotic depression, but these differences did not reach statistical significance. CONCLUSIONS: These results suggest that DSM-III-R schizoaffective disorder is close to schizophrenia and largely corresponds to mainly schizophrenic schizoaffective disorder in the Research Diagnostic Criteria, whereas DSM-III-R mood-incongruent psychotic depression is probably quite heterogeneous and should be studied further.

Adult↗
PubMed1997

"Are you depressed?" Screening for depression in the terminally ill.

OBJECTIVE: This study compared the performance of four brief screening measures for depression in a group of terminally ill patients. The methods included 1) a single-item interview assessing depressed mood, 2) a two-item interview assessing depressed mood and loss of interest in activities, 3) a visual analog scale for depressed mood, and 4) the Beck Depression Inventory-Short Form. METHOD: Semistructured diagnostic interviews for depression were administered to 197 patients receiving palliative care for advanced cancer. The interview diagnoses served as the standards against which the screening performance of the four brief screening methods was assessed. RESULTS: Single-item interview screening correctly identified the eventual diagnostic outcome of every patient, substantially outperforming the questionnaire and visual analog measures. CONCLUSIONS: Brief screening measures for depression are important clinical tools for terminally ill patients. For diagnostic purposes, however, they do not approach the validity of a single-item interview that asks, in effect, "Are you depressed?"

Aged↗
PubMed2004

Using a self-report depression scale to identify remission in depressed outpatients.

OBJECTIVE: Some have suggested that standardized rating scales be used in clinical practice to monitor the course of treatment; however, the time demands of clinical practice make it difficult to use such measures. This study derived a cutoff on a self-report depression questionnaire corresponding to the most widely used definition of remission (a score < or =7 on the 17-item Hamilton Depression Rating Scale). METHOD: Two hundred sixty-seven depressed outpatients were rated on the Hamilton depression scale and completed the Clinically Useful Depression Outcome Scale (CUDOS). The authors used receiver operating curve analysis to examine the ability of the CUDOS to identify remission on the Hamilton depression scale. RESULTS: A high level of agreement was found between the self-report and Hamilton depression scale assessments of remission. CONCLUSIONS: Self-report questionnaires represent a practical option for thoroughly and objectively evaluating the course of treatment and determining remission in depressed patients.

Adolescent↗
PubMed2005

Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression.

OBJECTIVE: Depression is commonly found as a coexisting condition in dementia. An earlier retrospective study by the authors found that patients with coexisting dementia and depression (CDD) were high utilizers of inpatient and nursing home care. The current prospective study was designed to investigate specific factors that might contribute to outcomes such as nursing home placement by examining the detection and course of CDD subjects as compared with subjects with either disorder alone. METHODS: Eighty-two subjects (N=29 with CDD, N=27 with Depression Alone, and N=26 with Dementia Alone) were recruited and reassessed at 3, 6, and 12 months after baseline assessment. RESULTS: Lower rates of depression detection by treating (non-study) physicians were found in CDD subjects. Only 35% of the CDD group were correctly diagnosed and receiving adequate treatment for their depression. Although the CDD group did not differ in baseline dementia stage or cognitive functioning as compared with the dementia-only group, they had significantly higher levels of functional impairment. CDD subjects used nursing home care at significantly higher rates; nursing home placement correlated significantly with baseline severity of functional impairment and mood measures, but not with other factors, including dementia stage and medical burden. CONCLUSIONS: Undetected, untreated, or inadequately treated depression may result in higher rates of nursing home placement in patients with dementia by increasing their functional disability. Aggressive outpatient treatment of depression could improve the course of coexisting dementia and depression.

Aged↗
PubMed2004

Depressive symptoms and alcohol consumption among nonalcoholic depression patients treated with desipramine.

OBJECTIVE: There are few data addressing the effect of alcohol consumption on response to antidepressants among nonalcoholics with depression. Similarly, the effect of antidepressant treatment on alcohol consumption in this group is not yet understood. This study focuses on changes in depressive symptoms and alcohol consumption in response to treatment with desipramine. METHOD: Twenty-seven nonalcoholic outpatients with major depression (as determined by the Schedule for Affective Disorders and Schizophrenia-Lifetime Version) completed measures of depression (that is, the 17-item Hamilton Depression Rating Scale and the Beck Depression Inventory) and alcohol consumption at intake and after 5 weeks of open treatment with desipramine. Subjects were characterized as minimal or mild-to-moderate drinkers. RESULTS: There was no significant difference between the groups with respect to effectiveness of antidepressant treatment. Analysis for repeated measures demonstrated that alcohol consumption with desipramine was significantly lower after treatment than at intake (F = 4.8, df 23:2, P < 0.01). Further, carbohydrate consumption was also significantly lower after treatment than at intake (F = 4.4, df 23:2, P < 0.05). CONCLUSIONS: Desipramine treatment appeared to result in decreases in alcohol consumption in nonalcoholic patients with depression. Further research is needed to elucidate the effect of alcohol consumption on the course and outcome of major depressive illness among nonalcoholics as well as the effect of antidepressant medication on alcohol consumption in this population.

Adult↗
PubMed2000

Self-efficacy as a mediator between stressful life events and depressive symptoms. Differences based on history of prior depression.

BACKGROUND: Self-efficacy, a characteristic that is protective against depressive symptoms, may be undermined by stressful life events. AIMS: To estimate the effects of stressful life events on self-efficacy, and to examine self-efficacy as a mediator of the effect of stressful life events on symptoms of depression. METHOD: Using a sample of 2858 respondents from the longitudinal Americans' Changing Lives study, path analyses were used to evaluate interrelationships between self-efficacy, life events and symptoms of depression controlling for a variety of potentially confounding variables. Separate models were estimated for those with and without prior depression. RESULTS: For those with prior depression, dependent life events had a significant, negative impact on self-efficacy. For those without prior depression, life events had no effect on self-efficacy. CONCLUSIONS: For those with prior depression, self-efficacy mediates approximately 40% of the effect of dependent stressful life events on symptoms of depression.

Depression↗
PubMed2000

Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression.

BACKGROUND: Depression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed. AIMS: We chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns. METHOD: One hundred and five patients with ICD-10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects. RESULTS: Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. CONCLUSIONS: The results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.

Adolescent↗
PubMed2004

Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.

BACKGROUND: Little is known about the efficacy of educational interventions for reducing the stigma associated with depression. AIMS: To investigate the effects on stigma of two internet depression sites. METHOD: A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive-behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention. RESULTS: Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive-behavioural therapy literacy. CONCLUSIONS: The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.

Adult↗
PubMed2005

Distinguishing bipolar depression, major depression, and schizophrenia with the MMPI-2 clinical and content scales.

Clinical and content scales from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) were used to examine the capacity of these scales to assist in the differential diagnosis of a sample of 212 psychiatric patients-137 with major depression; 43 with schizophrenia; and 32 with bipolar disorder, depressed state. Consistent with the previous literature, the clinical scales Depression (D), and Schizophrenia (Sc), and the content scales Depression (DEP), and Low Self-Esteem (LSE) best distinguished major depression from schizophrenia; the content scale DEP proved to be the most powerful predictor in distinguishing bipolar depression from schizophrenia. No clinical or content scale proved to be effective in distinguishing patients with bipolar depression from patients with major depression. In general, the content scales outperformed the clinical scales.

Adult↗
PubMed2000

Major depression, double depression and personality disorders.

Personality disorders are much more common among depressive patients than among normal people. Until now, little research has been conducted into the prevalence of personality disorders among patients with both major depression and dysthymia (double depression). The subject of this study is whether depressive patients with dysthymia have more personality disorders than those with no dysthymia. The Vragenlijst voor Kenmerken van de Persoonlijkheid (a Dutch self-report based on the International Personality Disorder Examination) was completed for 211 outpatients with major depression. Approximately 60% of the patients suffer from one or more personality disorders. Depressive patients with dysthymia differ little from the patients without dysthymia, but patients with dysthymia have more cluster A disorders and are more avoidant. Depressive patients without dysthymia do not differ from the patients with dysthymia in terms of symptoms. Depressive patients with personality disorders have significantly more symptoms than the patients without these disorders. There is no interaction between dysthymia and personality disorder.

Adult↗
PubMed1999

Possible precipitants of psychiatric hospitalization in patients with major depression: results from the Jerusalem Collaborative Depression Project.

In spite of substantial advances in the treatment of major depression by pharmacotherapy and other means, a significant number of depressed patients require hospitalization. In the context of the Jerusalem Collaborative Depression Project, possible precipitants of psychiatric hospitalization were sought in a cohort of patients (n = 107) who were admitted to hospitals in the Jerusalem area during a 14-month period because of a depressive episode. The patients fulfilled DSM III-R criteria for major depression, single or recurrent; bipolar 1 disorder, depressed or mixed; bipolar 2, depressed. The cohort encompassed more than two thirds of potential subjects admitted during this period with the ICD-9 equivalents of the specified diagnoses (as reported to the Israel Ministry of Health National Psychiatric Case Register) and were similar to the entire potential population in terms of their diagnostic breakdown. The patients underwent extensive socio-demographic and clinical evaluation that included detailed documentation of treatment received prior to hospitalization. Notwithstanding the absence of a comparison group of depressed patients who were not hospitalized, a number of potential precipitants were identified. These included older age (55.2% > 60 years, 20.6% > 70 years), immigration to Israel during the preceding 5 years (34.7%), concomitant physical illness (60%) which was associated with moderate to severe disability in 41% and poor quality of antidepressant pharmacotherapy prior to hospitalisation (only 24.3% received an adequate trial of antidepressant medication). Further evaluation of these and other potential factors could facilitate targeting of patient groups at particular risk for hospitalization and reduce the need for it.

Adult↗
PubMed2000

Evaluation of the relationship between depression and fibromyalgia syndrome: why aren't all patients depressed?

OBJECTIVE: To examine the relationship between fibromyalgia syndrome (FM) and depression by determining the set of factors that differentiate FM patients with and without depressive disorders. METHODS: A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories. RESULTS: Of the sample, 39 met criteria for depressive disorder and 30 did not. Depressed patients with FM were significantly more likely to live alone, report elevated functional limitations, and display maladaptive thoughts than nondepressed patients. Nondepressed patients were significantly more likely to have received prior physical therapy than depressed patients. Pain severity, numbers of positive tender points, and pain intensity of tender points and control points did not differentiate the depressed and nondepressed patients. Discriminant analysis revealed that living status, the perception of functional limitations, maladaptive thoughts, and physical therapy treatment together identified diagnoses of depressive disorders for 78% of the patients. CONCLUSION: Concurrent depressive disorders are prevalent in FM and may be independent of the cardinal features of FM, namely, pain severity and hypersensitivity to pressure pain, but are related to the cognitive appraisals of the effects of symptoms on daily life and functional activities.

Depression↗
PubMed2002

Stability of retrospective reports in depression: traumatic events, past depressive episodes, and parental psychopathology.

Research findings based on the retrospective reports of depressed individuals have long been held suspect because of possible negative reporting biases associated with depression. In the present study we assess the stability of retrospective reports of past traumatic events, past depressive episodes, parental depression, and parental substance abuse in a sample of 234 adults whose depression status changed over two assessments conducted one year apart. Depression status was found to affect reporting of number of past depressive episodes and past traumatic events, but not reporting of parental psychopathology. Implications of these findings are discussed for research that relies on the retrospective self-reports of depressed participants.

Adolescent↗
PubMed1991

[Discrepancy between clinical depression and psychometric depression].

Convergencies and discordances among three different strategies for the psychometric evaluation of depressively (self-report inventories, objective or external questionnaires, and verbal content analysis) are discussed. Twenty-one inpatients with a major depressive disorder, and 21 inpatients with a non-endogenous depression were assessed with different instruments. While an external assessment of depressiveness coincided with both clinical and diagnostical criteria, depressiveness as assessed with self-report inventories, and verbal content showed lesser scores among patients with endogenous depression (n-21): Such patients assessed themselves as "less depressive" than patients with dysthymic disorder (n-21), even when admitted at a mental hospital. Results suggest that any assessment--as far as endogenous depression is concerned--should be basically performed by means of external evaluation questionnaires.

Depressive Disorder↗
PubMedDate not supplied

[Representations of causality and depression. A factorial approach to the resignation model in the depressed patient].

The present study investigates causal attributions for stressful life events within the context of Beck's cognitive theory of affective disorders and Seligman's learned helplessness model of depression. The aim was to assess the validity of the depressive attributional style proposed by Seligman, with a clinically depressed population for negative life events. This study presents a factor analysis of the causal attributions of depressed psychiatric in patients measured in relation to one negative life event per subject. The experimental procedure consisted in asking 71 ward depressed patients (51 females and 20 males) to answer 15 items along a seven point scale in order to assess the causes, consequences and control attributed. Statistical treatment using both multidimensional analyses (to describe the dimensions of causality) and univariate comparisons show: 1. The existence of a three dimensional solution, which is interpreted in terms of Seligman's reformulated helplessness model, and which confirms the notion of a "depressive attributional style". 2. A positive relationship between intensity of depression and the tendency to generalize the effects of negative life events (dimension of globality in Seligman's model and generalizability in Beck's). As this relationship is a function of the level of depression it is considered as a psychological state rather than as a personality trait. 3. Inter-sex differences with regard to the attribution of personal versus universal control, with female patients indicating more personal helplessness in relation to others. The results are discussed in relation to epidemiological data and personality theory.

Adult↗
PubMed1979

Depression in family practice: changes in pattern of patient visits and complaints during subsequent developing depressions.

This study was done to characterize changes in patient behavior during specific time periods immediately before first, second, third, and fourth episodes of depression. Forty-three patients from a group of 154 depressed patients examined in an earlier study developed 59 subsequent episodes of depression, and these were the patients used in this study. Suitable age and sex matched controls were also examined for the same time periods. The depressed patients and controls were patients in a rural solo practice. The depressed patients showed increased number of patient initiated visits, increased incidence of hospitalization, increased number of functional complaints, increased number of pain complaints, and increased feelings of tension as compared to controls during the seven months prior to the diagnosis date of the first and each succeeding episode of depression. The study results indicate that increased numbers of office visits, functional complaints, pain complaints, and anxiety complaints can be harbingers of a clinical depression, whether it be the index (first) or a subsequent depressive illness.

Depression↗
PubMedDate not supplied

[Dementia-depression: how are they related? From depressive pseudodementia to pseudodepression in dementia].

Dementia and depression are among the most frequent and disabling conditions in the elderly. The prognosis of depression is similar in young and elderly patients; however, treatment can be more risky in the latter. Incorrect diagnosis of dementia as well as therapeutic relentlessness should be avoided. An attempt is made to clarify the ways dementia and depression can combine. The reality of pure depressive pseudodementia seems doubtful. Depression can worsen a dementia. Cognitive dysfunction can be observed in depression, though it is difficult to estimate the extent and the meaning of this association. Patients with very mild dementia are often referred for a depression, which is ruled out by careful examination. There is no simple mean to differentiate dementia from depression. The proper way remains to perform a strict clinical, neuropsychological and psychiatric examination.

Aged↗
PubMed1996

Improvement in subjective work performance after treatment of chronic depression: some preliminary results. Chronic Depression Study Group.

We analyzed the relationship between depression and patient-assessed or clinician-rated work performance among chronically depressed patients followed for 12 weeks in a large clinical trial. The data were collected in a double-blind design comparing sertraline, a selective serotonin reuptake inhibitor, with imipramine, a tricyclic antidepressant, in 12 academic centers nationwide. Incorporating work-related questions from a portfolio of rating scales used to assess depression, we constructed several measures of work performance, assessed at baseline and at Week 12 of the clinical investigation, and examined how they changed with improvement in depressive symptoms. As depressive symptoms subsided following treatment, patients reported substantial improvement in our measures of work performance. Eighty-six percent of the cohort reported some improvement from base-line to Week 12. The extent of improvement in work performance correlates highly with improvement in the depressive symptoms measured on the Hamilton Rating Scale for Depression. Treatment of depression with antidepressant medications resulted in substantial improvement in subjective work performance among the patients studied.

1-Naphthylamine↗